title: Esophageal histoplasmosis in a renal allograft recipient.
abstract: Histoplasmosis is a progressive granulomatous disease caused by the intracellular dimorphic fungus Histoplasma capsulatum. We report a rare case of esophageal histoplasmosis in a renal allograft recipient. A 55-year-old male who received a live, unrelated renal allograft 20 years ago presented with complaints of recurrent fever for ten to 12 months, weight loss over six months, progressive dysphagia more for solids for five to six months and joint pain and swelling involving the bilateral metacarpo-phalangeal and proximal interphalangeal joints. Biopsy from the esophageal ulcers revealed dense inflammation infiltrated with lymphocytes and macrophages with clusters of strongly positive intracellular fungal spores with a clear area or "halo-like" zone suggestive of Histoplasma capsulatum invasion. The patient was treated with intravenous liposomal amphotericin B for ten days and later switched over to oral itraconazole. Repeated endoscopy revealed significant improvement of the lesions.
authors.affiliation: Department of Nephrology, SMS Hospital and Medical College, Jaipur, India.
authors.forename: L C
authors.initials: LC
authors.lastname: Sharma
authors.forename: J
authors.initials: J
authors.lastname: Falodia
authors.forename: K
authors.initials: K
authors.lastname: Kalla
authors.forename: M
authors.initials: M
authors.lastname: Kalla
authors.forename: J B
authors.initials: JB
authors.lastname: Gupta
authors.forename: S S
authors.initials: SS
authors.lastname: Gupta
authors.forename: P
authors.initials: P
authors.lastname: Beniwal
authors.forename: M N
authors.initials: MN
authors.lastname: Singh
authors.forename: V
authors.initials: V
authors.lastname: Malhotra
authors.forename: D
authors.initials: D
authors.lastname: Agarwal
mesh_terms: D004935:Esophageal Diseases / Q000209:etiology* / Q000382:microbiology*; D006660:Histoplasmosis / Q000209:etiology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged